Novel and emerging treatments to target pathophysiological mechanisms in various phenotypes of MS.

The objective is to comprehensively review on novel pharmacotherapies used in multiple sclerosis (MS) and the possibilities they may carry for therapeutic improvement. Specifically, we discuss pathophysiological mechanisms worth targeting in MS ranging from well-known targets such as autoinflammation and demyelination to more novel and advanced targets such as neuroaxonal damage and repair. To set the stage, a brief overview of clinical MS phenotypes is provided followed by a comprehensive recapitulation of both clinical and paraclinical outcomes available to assess the effectiveness of treatments in achieving these targets. Finally, we discuss various promising novel and emerging treatments including their respective hypothesized modes of action and currently available evidence from clinical trials. Significance Statement This comprehensive review discusses pathophysiological mechanisms worth targeting in multiple sclerosis. Various promising novel and emerging treatments including their respective hypothesized modes of action and currently available evidence from clinical trials are reviewed.